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General NPI Number Information
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NPI Number | 1093726523
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Entity Type | Individual
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Provider Name | RICHARD E MOOSE MD
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Gender | Male
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 03/01/2021
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Provider Practice Location Address
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Address Line | DECKER STUDENT HEALTH SERVICES CENTER 4400 VESTAL PARKWAY EAST
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City | BINGHAMTON
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State | NY
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Zip | 13902
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Country | US
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Telephone | 607-777-2221
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Fax | 607-777-2881
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Provider Business Mailing Address
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Address Line | 4400 VESTAL PKWY E
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City | BINGHAMTON
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State | NY
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Zip | 13902-4400
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Country | US
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Telephone | 607-777-2221
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Fax | 607-777-2881
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 203760-1
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License Number State | NY
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